SYNDROME obstructive lung disease – COPD

Definition:

Syndrome characterized by progressive airflow limitation associated with abnormal inflammatory response of the lungs to noxious particles.
In this entity includes:
– Chronic bronchitis
– Emphysema
– Asthma

1. Emphysema
Condition characterized by dilation of bronchioles and pulmonary alveoli accompanied by structural changes of the alveolar wall (destruction of alveolar septa).

Anatomical classification:
– Pan-lobular diffuse (whole parenchyma is affected)
– Centro-lobular (located only in the central part of the lobe of the lung, the alveoli in the periphery of the lobule remain unchanged)

Clinical picture:
Debut poor in manifestation. These occur when processes lesion alters one third of lung capacity.
Is characteristic clinical signs of wheezing dyspnea as + / _ coughing. Dyspnea is installed gradually, gradually becoming troublesome, accompanied by cyanosis. Cough and expectoration occur in advanced stages. While it installs right heart failure characterized by turgid jugular, swelling in the legs, hepatomegaly.
Objective clinical Ex:
– Thorax globular, with widened intercostal spaces,
– In advanced stages – cyanosis of the extremities, cyanosis perioronazala
– Hypersonority
– Breath sounds abolished
Laboratory picture:
– Ex Rx – hipertransparenta pulmonary leveling ribs, widened intercostal spaces
– Ex sg – changing blood gases – oxygen saturation decreases, increases CO2 – respiratory failure
– Probe ventilator – spirometry – lung hyperinflation syndrome (VR, CRF increased CPT), bronchial obstruction syndrome (FEV low)
Treatment:
Prophylactic – removing the etiological factors (the same as those of chronic bronchitis)
Medicine
– Methylxanthines – Miofilin
– Cough – Codeine Phosphate
Respiratory gymnastics
In severe cases – intermittent oxygen

February. COPD
Combines clinical symptoms of chronic bronchitis emphysema.
Depending on the predominance may be:
– Predominantly bronchitis
– Predominantly emphysematous
Clinical picture:
At the onset symptoms is low then a cough, sputum, dyspnea
Dyspnea occurs in the effort then started becoming more intense and may even rest.
Ex Clinic
– Skin of the extremities are warm, cyanotic
– Polipnee
– Wheezing
– Thorax with diameters increased
– The amplitude of respiratory movements diminished
– Patients who prefer certain positions to ease expired – at the bedside, on the windowsill
– Hypersonority
– Decreased vesicular murmur
– Disseminate bronchial crackles on both lung areas
Laboratory picture:
1. Ex Rx:
– Increased chest diameter
– The amplitude of respiratory movements decreased
– Travel cost low amplitude
– Hiluri dilated pulmonary
– Hipertransparenta pulmonary
2. Ventilatory Probe:
– CV low
– Decreased FEV
– Progression to respiratory failure
Treatment Objectives:
– Prevention of disease progression
– Decreased symptoms
– Prevention of complications
– Prevent and treat exacerbations
– Stopping smoking
Medicines
1. Bronchodilators – methylxanthines, beta2 sympathomimetics, anticholinergics
2. Inhaled glucocorticoids
3. Antibiotic – in infectious exacerbations
4. Mucolytics – coughing
5. Cough – cough
6. Oxygen therapy in severe cases
Predominant function of the two syndromes, COPD shows two clinical types:
Type A – “pink puffer” – predominantly emphysematous – “Pink pufaitorul”
– Progressive dyspnea, cough and sputum reduced minimum lining
– Tachypnea, prolonged expiration lips protrude
– Prefers position with your body above with supporting arms
– Exacerbations mucopurulent are rare but when they occur are serious respiratory failure
– Is complicated by chronic pulmonary heart – right heart failure – terminally
– Due accessory muscle use, the patient is weak, the suffering facies with obvious weight loss
– Turgid jugular
– Hypersonority broadcast, absence or reduced cardiac dullness, diminished vesicular murmur, apex absent or weakly perceptible shock – signs of lung hyperinflation
– Radiological – hipertransparenta pulmonary bronchovascular drawing erased, and fell flat diaphragm, cardiac silhouette elongated heart “droplets”
– Exercise capacity is severely impaired
Type B – “blue bloater” – mostly bronchitis – “blue eagle”, “blue mackerel”
– Big Smoke, cough with sputum lining large
– Coughing is started in cold weather this then becomes permanent
– Exacerbations mucopurulent are increasingly frequent and longer episodes of severe respiratory failure
– Dyspnea is less severe
– The patient is overweight, cyanotic, edematous (cardiac edema in right heart failure)
– Hypersonority pulmonary, bronchial rales, weesing
– Signs of right heart failure – turgid jugular, edema, hepatomegaly, hepato-jugular reflux
– Hypoxia peripheral – Hippocratic fingers, peripheral and central cyanosis
– Radiological – thickening of the bronchial walls with accentuated pulmonary drawing, hiluri enlarged right heart cavities increased
– Gas meter – hypercapnia (PaCO2> 60mmHg), hypoxia increase PaO2 <60mmHg)
– Ex blood – hemoglobin desaturation is due to erythropoiesis stimulated with increasing hematocrit (55% – 60%) – polyglobulia

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